Future FPs Share Their Vision for Family Medicine

Dreana Jett, Lewis Katz School of Medicine at Temple University (AAFP Foundation Family Medicine Leads Emerging Leader Institute participant): I knew it was for me when I attended my first Pennsylvania AFP conference, being surrounded by people who were so passionate about the work they do and their ability to fill the gaps in their communities’ needs. These were docs from all across Pennsylvania, some in major cities, some in more rural parts. Everyone was doing things that were so different, but so cool, in each of their practices. I also got to speak to residents who were there presenting for their programs. Being in that space, meeting my future colleagues, solidified that I wanted to go into family medicine.

Garrett Kneese, Long School of Medicine at UT Health San Antonio (student delegate to the AAFP Congress of Delegates): I became sure of family medicine right about the time the COVID-19 pandemic struck. I had a chance to move to the Texas-Mexico border and work on some community health programming to mitigate the disproportionate effects of the pandemic there. As someone with a strong public health commitment, I realized that family medicine, especially academic family medicine, was going to be the place where I could synthesize those two fields of individual patient care and community-centered population health work more effectively than in any other specialty

Rebecca Stoll, M.S., Alabama College of Osteopathic Medicine (former student delegate to the AAFP’s Congress of Delegates and FMIG regional coordinator): I didn’t really have any understanding of life beyond medical school when I got into medical school. Nobody in my family was a physician, so the idea of residencies and fellowships was all foreign to me. All I knew was that I loved geriatrics. So, I learned I could either do internal medicine or family medicine. I started to learn more about family medicine in my first year and how it included women’s health and taking care of all ages, which definitely pushed me toward family medicine. That love of family medicine grew after I attended my first Alabama AFP conference the summer between my first and second years.

It wasn’t until my third year that I thought, “This is absolutely the specialty for me.” I didn’t have an outpatient family medicine rotation until January of my third year, and I had been struggling in that fall semester because everything was inpatient, and I wasn’t a fan of inpatient medicine. I asked myself, “Am I in the right field? Should I even be in medicine?” And then I finally had that outpatient family medicine rotation, and I started hearing feedback from patients asking, “When are you going to be a doctor? Can you be my doctor?” I felt like I was in the right place, and it wasn’t ever going to change after that. All my leadership roles with the AAFP helped as well, because it made me feel like I fit in with the community in family medicine.

Katrina Perez-Vokt, Tufts University School of Medicine (AAFP student liaison to the Latino Medical Student Association): I didn’t really know about family medicine until starting medical school, but I think it’s been silently calling to me all through medical school because I have always been rooted in primary care and working with the community. When I started going through my clinical rotations and I did family medicine, I realized this is where I can care for patients from when they’re born all the way to the end of life. And one of my big interests is maternal and child care, so being able to care for women and children was an important aspect for me.

AAFP News: What experiences or connections helped you best explore the specialty?

Jett: During my first year of medical school, we had a primary care exploration elective where medical students who were interested in primary care were partnered with mentors. My mentor was Dr. Margot Savoy, so I got to spend time in our family medicine clinic. It was awesome seeing how she interacted with patients and the range of patients. We had patients of all ages in the clinic. There also were a lot of procedures. That early exposure to family medicine and all that it could be as a first-year medical student really helped solidify my interest.

Kneese: For me it was my clerkship experience. I know that’s somewhat biased to universities that actually have a family medicine clerkship, but my experience was transformational. I worked in an academic health center that practices in an advanced primary care model and has a really strong in-patient service where many of our patients who become hospitalized become our patients for the family medicine hospital service. I got a comprehensive idea of what it’s like to be a modern family doctor and the way our system is growing toward community-oriented care models and patient-centered medical homes. I got a strong idea of what community-oriented advanced primary care looks like, and I can’t imagine myself doing anything more valuable for the communities I’ll get to serve someday as a family doctor.

Stoll: I think my experiences in Tallahassee, where my third and fourth year have been, have shown me one side of family medicine, but I’m so thankful for the AAFP because I feel like family medicine is so different across the country. Through my work with the AAFP and working with schools in other parts of the country, I’ve gotten to see all that’s within family medicine and all that family medicine can be. Without the AAFP I would have a limited view of the specialty.

Perez-Vokt: The first experience that comes to mind is something that’s integrated into my medical school curriculum in our second year. We have an apprenticeship in primary care, and once a week we would shadow a primary care doctor. I worked with family physician Brent Fryling in Lynn, Mass., at a federally qualified health center. It was really my first deep dive into learning how to interact with patients and thinking through care plans. That was an influential experience for me that helped cement my love for family medicine.

AAFP News: Throughout the match process, what did you learn about family medicine from talking to people from so many programs?

Kneese: Even though I only applied to academic family medicine programs, I feel like there was still a lot to learn about the way family medicine has themes of focus from one part of the country to another. What I mean by themes is primarily looking at things like special populations of interest as well as specialization tracks for a fourth year (or fifth year if it’s a four-year program). Some programs in some parts of the country are really into street medicine and addiction medicine. Some parts of the country are into migrant health. Some parts of the country are into care integration with tertiary health systems, so inpatient and obstetric care is more of a focus there. That gave me better idea of how to fine-tune residency to the unique interests you have. It’s clear to me from talking with colleagues interviewing in their respective specialties that the heterogeneous nature of programs is much more accentuated in family medicine than in other specialties. It’s incredibly diverse from one part of country to another.

Jett: As I was going on interviews, I realized just how diverse the different interests and focuses can be, as well as the difference in some large, academic major cities versus smaller suburban or rural areas. For example, if you’re at a larger institution that has an entire academic center for HIV primary care, family docs might not do that as much.

Stoll: I loved the interview process because of how much I learned. I felt like every conversation reassured me that I was making the right decision because of the people that I met and how kind and approachable they were. I learned that there are so many different aspects of family medicine. I understood that going in, and everyone always says, “Family medicine is so broad. There’s so much you can do in family medicine.” But there were things programs were doing that I had never heard of. One program had a clinic for residents that was just a teen pregnancy clinic, and I was like, “Wow, what a great focus and something that I would be so interested in.” I knew other programs were involved in free clinics and HIV and LGBTQ care, but it was nice to see how broad that really is and how much different programs offer.

Perez-Vokt: While applying for residency I knew one of my big interests in family medicine was maternal and child health, and I had a lot of questions about what practicing OB as a family medicine doctor looks like. Throughout the process I learned that there are OB fellowships available after general family medicine training, and programs offer different levels of OB/labor-and-delivery experience. Meeting residents and faculty and hearing about their experiences helped me to solidify my interest in outpatient prenatal care and maternity care, but the L&D lifestyle wasn’t for me.

AAFP News: What makes you most excited about choosing family medicine?

Jett: The infinite options. Going in I knew I wanted to get good training in everything so I could have options when I graduated. As I’ve gone through my fourth year, I’ve been exposed to so many subspecialties. For example, I’m on ICU now, and I’m working a lot with palliative care, which is something I didn’t realize I was interested in. That’s an option I can do if I decide I want to step back from other areas. The options exist in family medicine to make it whatever your interests are during different phases of your life. Your career will always be evolving as a family doc. That’s so exciting.

A lot of programs are family and community medicine. When I think of family docs who inspire me, all of them are out in the community making a difference. They’re in tune with what their patients and communities need. That’s one thing family medicine does, identify gaps and find a way to fill those gaps. As new problems emerge, family docs are always going to be in position ahead of the curve to respond to needs when they arise.

Stoll: Family medicine has done a great job of filling health care gaps. I feel like there are so many more gaps in our current health care system that family medicine is perfect to fill, whether that’s rural medicine, LGBTQ care or HIV care. I’m excited about that future of family medicine and working toward health care equity and making sure that our patients are taken care of. One of the reasons I chose primary care is I’m passionate about health care for all. One way I think that we can address health care inequities is by reducing health care costs, and the best way that we can do that is prevent people from going to the hospital in the first place. If I can keep someone out of the hospital, not only is that better for that patient, it’s better for our health care system in general.

Perez-Vokt: Having longitudinal relationships with patients and the opportunity to find my niche in family medicine. I’m excited to have a variety of skills by the time I graduate and be able to connect with patients and provide excellent care for my communities.

Kneese: As we transition into more of a “One Health”-focused system, the range of a physician is going to increasingly dictate not only their utility to the communities they serve but also to their own quality of practice and quality of life. Being able to pivot with the system-level shifts will be crucial. In context, system-wide shifts used to occur every 20 to 30 years, which might be once in your whole career. For us, I believe it’s going to be about every 10 years. Today, we’re witnessing massive innovations that are going to change the way we practice vastly, rapidly and with increasing frequency (artificial intelligence, value-based reimbursement, coverage expansions, etc.). I’m excited about the foundation of range, flexibility, value and utility that family medicine will provide as a community-oriented physician. I’m confident that most, if not all, of the family physicians I train with are going to be confident in their ability to make these frequent pivots for the benefit of their communities.

AAFP News: What advice do you have for students who are considering family medicine?

Jett: When I talk to second- and third-year students considering family medicine I tell them to keep their passion. That’s the major thing. Continue with the path. As you go through medical training in some large institutions, people may try to dissuade you from primary care, but I think most people go into medical school because they care deeply about changing the lives of their patients and helping their patients. That’s what family docs do. We look at the whole person and the whole family. As long as you keep your passion alive, you’ll be an awesome family doc with plenty of options.

Kneese: If someone is already choosing family medicine, my advice for them going into residency would be find your niche that keeps you interested in the work that you do during training, because it’s going to be a hard three or four years. Having your passion projects to keep you engaged in the purpose you are serving as a resident physician is critical to your wellness and development in this final stage. Also know that you are entering a residency training that is building a broad foundation that you can build off later. If that niche interest changes, you can be guaranteed that it will still deeply impact the next niche you find a passion for.

Stoll: For me, it was truly about finding where I fit in. I had a preceptor explain this to me as a third-year student, and I didn’t understand what he meant until I was 100% sure in my decision. But he was talking about making sure that the fit is not just about lifestyle and all of the things that people typically think about. It’s also about personalities. He said, “Take a look at the community around you in that specialty. Do you fit in with that community?” And I think that’s the best advice I would give anybody still undecided, because I truly felt like I fit in a family medicine community, which isn’t hard, because we are so broad and everyone is so nice.

I would also say try to remove outside influences. Everybody’s going to have opinions on what you should do with your life, but this is a lifelong decision that we’re making. So, there are things that you’re going to love. I loved ICU, but I’m not sure I would love it forever. I wanted to pick something that I knew I would love forever rather than just for a month or so.

Perez-Vokt: Follow your heart. When you’re on rotations, you’re going to meet a lot of different people with a lot of different teaching styles in a lot of different settings, but when you find that environment that aligns with your own interests and your mission, that’s when you know what specialty you should go into.

I would also advise going to the AAFP’s National Conference. I didn't hear about until I started applying in my third year. I wish I had gone for a second year, because it has so much to offer. There are so many people you could connect with and more things you could learn about family medicine by going to that conference. I definitely encourage people to attend that event early on.

AAFP News: What do you think family medicine will look like 20 years in the future?

Kneese: I see family physicians being the utilitarian specialists of our communities in similar ways to what we’re seeing other first-tier health systems in the world already accomplishing. We’re going to see the landscape shift even further by the capabilities of the technologies we will utilize to reduce administrative burdens substantially, improve our clinic-based diagnostic processes, and automate everything from patient charting to insurance mitigations for medications, procedures and testing. What that’s going to do is free up hours a day for family physicians to re-engage with their communities, not only on a patient and family level, but on a community and sociopolitical level as well. We’ll see physicians who have stereotypically been drowning in their notes, when they’re not seeing 30 patients a day in 15-minute slots suddenly being able to leverage an incredible wealth of understanding from the personal level to the population level to continue this momentum we have toward a more just and equitable health system.

Jett: The future looks bright for family medicine. There are more programs that are being developed and created. The field is expanding. The need for primary care doctors is only growing wider as more doctors retire. Now is definitely a great time to enter the field. Additionally, there are a lot of creative models coming. A lot of my peers are interested in exploring direct primary care. That’s something we’ll see more and more of in the future. We also know alternative payer models are being developed as we speak. There are models being trialed to reimburse people for performance rather than procedures. We know primary care docs are awesome at prevention and saving the health system money, so I think the new models will reflect how vital we are to the system.

Perez-Vokt: I think family medicine and primary care in general is going to help our health system, and I hope it continues to proliferate and become more robust across the country.

Stoll: There’s always going to be work for family medicine physicians because we are prepared to take on whatever our patients may need, even if it’s a little bit outside of our comfort zone. I’m looking forward to seeing how we as a specialty can continue to be primary care leaders. How can we improve health equity and make sure that we’re doing as much as we can for our patients? I actually said this in one of my interviews. The interviewer asked, “What do you want to leave me with? What should I know about you?” And I said, “I want you to know that I’m a family medicine physician of the future. I’m excited to do the work and see how we can not only improve our specialty but also improve the health care of the country.”